Question:
Which is not seen in digoxin toxicity?
Which is not seen in digoxin toxicity?
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Digoxin slows AV node and the ventricular rate but does not convert AF to a regular rhythm.
Updated On: Jun 24, 2026
- Bidirectional ventricular tachycardia
- Paroxysmal atrial tachycardia
- Ventricular bigeminy
- Regularisation of atrial fibrillation
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The Correct Option is D
Solution and Explanation
Step 1: Digoxin toxicity produces arrhythmias through two combined mechanisms: increased automaticity (from intracellular calcium overload) and depressed AV nodal conduction (from enhanced vagal tone). The question asks which finding is NOT seen.
Step 2: Bidirectional ventricular tachycardia is a classic, almost pathognomonic, arrhythmia of digoxin toxicity caused by enhanced ventricular automaticity. This is seen.
Step 3: Paroxysmal atrial tachycardia, characteristically with AV block (PAT with block), is a well-known manifestation combining increased atrial automaticity with AV conduction block. This is seen.
Step 4: Ventricular bigeminy (alternating normal beats and ventricular premature beats) results from increased ventricular automaticity and is a common early sign of toxicity. This is seen.
Step 5: In atrial fibrillation, digoxin slows AV conduction and reduces the ventricular rate, but it does NOT convert AF back to sinus rhythm or regularise it. Regularisation of the ventricular response in AF would instead suggest development of complete heart block with a junctional escape, but simple regularisation of atrial fibrillation is not a recognised feature of digoxin toxicity. Hence it is the exception.
Conclusion: The correct answer is Regularisation of atrial fibrillation, matching the printed key.
Step 2: Bidirectional ventricular tachycardia is a classic, almost pathognomonic, arrhythmia of digoxin toxicity caused by enhanced ventricular automaticity. This is seen.
Step 3: Paroxysmal atrial tachycardia, characteristically with AV block (PAT with block), is a well-known manifestation combining increased atrial automaticity with AV conduction block. This is seen.
Step 4: Ventricular bigeminy (alternating normal beats and ventricular premature beats) results from increased ventricular automaticity and is a common early sign of toxicity. This is seen.
Step 5: In atrial fibrillation, digoxin slows AV conduction and reduces the ventricular rate, but it does NOT convert AF back to sinus rhythm or regularise it. Regularisation of the ventricular response in AF would instead suggest development of complete heart block with a junctional escape, but simple regularisation of atrial fibrillation is not a recognised feature of digoxin toxicity. Hence it is the exception.
Conclusion: The correct answer is Regularisation of atrial fibrillation, matching the printed key.
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